Pediatrics Unit

The three sides of the pediatric assessment triangle include:

Appearance, Breathing, Circulation

What are the three sides of the pediatric assessment triangle?

Appearance, breathing, circulation

Which two pulse points should be checked and compared when assessing the circulation of infant patients?

Brachial and femoral

When forming a general impression about a pediatric patient, which of the following is true of a "sick" child?

Unaware of your presence

Breathing

Visually assess the child's ability to breathe and listen for breathing sounds

At what point during assessment should the pediatric assessment triangle be used?

When forming the general impression

Which of the following most accurately describes the emotional state of children in the early childhood stage?

Quick shifts from confident to unsure

Which of the following stages of emotional development is commonly experienced by infants?

Separation anxiety

Infancy includes children from birth to 1 year old.

True

Infants have the ability to recognize people, places, and objects.

True

Under what circumstances can a foreign body airway obstruction be removed from a pediatric patient's airway with the finger sweep method?

When the object is visible

Which of the following conditions are considered unstable in a child and require rapid transportation?

all of the above

Which of the following is a way in which a child might be exposed to a toxic substance?

all of the above

Which of the following is an example of a lower airway disease that may result in respiratory distress in children?

all of the above

Which of the following is true of adolescent intellectual development?

all of the above

Which of the following is typical of middle childhood social development?

all of the above

Which of the following items is important during management of pediatric shock?

all of the above

Which of the following questions should be asked to the caregiver of an injured child during scene size-up?

all of the above

Why must padding be placed beneath a child's shoulders during immobilization?

all of the above

Early respiratory distress

also called compensated respiratory distress, occurs when a child has an insufficient supply of oxygen, and therefore the body begins to compensate by increasing the respiratory rate.

Early childhood

also called the preschool years, includes children from 2 to 6 years old

Middle childhood

also called the school-age years, includes children from 6 to 12 years old.

Which of the following is a type of physical development that occurs during infancy?

All of the above

When does primary assessment for a pediatric patient begin?

"At the door"

Lower airway diseases in children include:

1) Asthma 2) Bronchiolitis 3) Pneumonia 4) Pertussis

upper airway obstructions commonly occur as a result of the following:

1) Croup 2) Foreign body obstruction 3) Tracheitis 4) Epiglottitis 5) Dysfunction with a tracheostomy

detailed physical examinations include:

1) DCAP-BTLS 2) Head 3) Neck 4) Chest 5) Abdomen 6) Pelvic Region and Extremities 7) Posterior

Common causes of shock in pediatric patients include:

1) Diarrhea or vomiting, leading to dehydration 2) Trauma, especially abdominal injuries 3) Blood loss 4) Infection

Make sure that your focused history includes the following information related to the child:

1) Duration of fever or current symptoms 2) Activity level 3) Recent foods or beverages consumed 4) Recent urine output 5) History of vomiting, diarrhea, or abdominal pain 6) Presence of rashes 7) Medications taken 8) Medication allergies 9) Past medical problems or chronic illness 10) Key events leading to the injury or illness

Pediatric respiratory emergencies exist at three levels:

1) Early respiratory distress 2) Decompensated respiratory failure 3) Respiratory arrest

Other causes of seizures include:

1) Epilepsy 2) Meningitis 3) Hypoxia 4) Hypoglycemia 5) Head injury 6) Drug and alcohol overdose or withdrawal 7) Metabolic disorders 8) Poisons

Signs of early respiratory distress include:

1) Increase in respiratory rate 2) Nasal flaring 3) Retractions in intercostal muscles, the neck, and above the clavicles 4) Abnormal breathing sounds, such as stridor and wheezing 5) See-saw breathing

Signs of shock in pediatric patients include:

1) Rapid respiratory rate 2) Pale, cool, clammy skin 3) Weak or absent peripheral pulses 4) Delayed capillary refill 5) Mottling 6) Absence of tears when crying 7) Decreased urinary output 8) Sunken fontanelles in the very young 9) Altered mental status

Common pediatric emergencies include:

1) Respiratory emergencies 2) Shock 3) Seizures 4) Toxic substances 5) Sudden infant death syndrome

Signs of respiratory arrest include:

1) Respiratory rate less than 10 bpm or no breathing at all 2) Limp muscle tone 3) Unresponsiveness 4) Slow or absent heart rate 5) Weak or absent pulse 6) Hypotension in children over 3 years old

Signs of decompensated respiratory failure include:

1) Respiratory rate over 60 bpm 2) Cyanosis 3) Increased use of accessory muscles to aid in breathing 4) Poor perfusion in extremities 5) Altered mental status 6) Grunting 7) Head bobbing

take note of the following items which include:

1) The physical appearance and positioning of the child 2) The appearance of the crib 3) The presence of toys and other items in the crib 4) The appearance of the room and the house 5) The presence of unusual or harmful items in the room 6) The presence of medications 7) The circumstances surrounding the discovery of the child 8) The time the infant fell asleep and the time the infant was discovered unresponsive 9) General health issues or recent illnesses 10) Date of last doctor appointment

Between which ages does early childhood occur?

2 to 6 years old

A child in middle childhood or adolescence will have an average body temperature of ____.

98.6°F

Which of the following may be used to determine a child's level of consciousness?

AVPU check

Which of the following is the correct response to a suspected SIDS infant who shows no signs of rigor mortis or lividity?

Aggressively attempt to resuscitate the infant through CPR

Which method may be used to administer oxygen to children who do not tolerate a face mask?

Blow by method

Why is a child's brain more prone to bleeding from an injury than an adult's brain?

Because a child's brain has less cushioning.

Why is it important for EMS providers to be able to recognize signs of respiratory distress in pediatric patients?

Because children with respiratory emergencies deteriorate quickly

Why are children able to compensate for shock for a long period of time?

Because their blood vessels constrict efficiently

toddlers #2

Children in their second year of life, this stage of life is filled with rapid progress in all areas of development.

Which of the following is true about children's rib cages?

Children's rib cages are more pliable than adults'.

Circulation

Determine the quality of the child's skin color.

Appearance

Evaluate the overall mental status, body position, and muscle tone of the child

Infants typically do not have any form of social development.

False

Why are the liver and spleen more prone to injury in children than in adults?

In children, these organs are not fully protected by the rib cage

What might a bulging fontanelle on an infant's head indicate?

Increased intracranial pressure

Stages of Childhood include:

Infancy, Toddlers, Early childhood, Middle childhood, Adolescents

Which of the following is an appropriate response to a child who is having a seizure?

Move unsafe items out of the child's way.

Which of the following is true about shock in children?

Once signs of shock appear, the child will deteriorate rapidly.

Which of the following is true about pediatric vital signs?

Pediatric vital signs are different, according to the age of a child.

There are four main areas of development which include:

Physical development, Intellectual development, Emotional development, Social development

What may occur if too much force is used when ventilating a child?

Pneumothorax

After the scene of an incident involving a child has been secured, which of the following is an appropriate manner for an EMS provider to enter the scene?

Take a moment to observe the big picture and look for clues

Why is a "trunk to head" evaluation sometimes recommended when performing a detailed physical exam on a small child who is not in critical condition?

The child may have less anxiety if the trunk of the body is examined before the head.

You are called to the scene of a bicycle accident involving a 10-year-old girl. She is alert and responsive. Her mother and several bystanders are also at the scene. To whom should you first direct your questions in order to obtain a SAMPLE history?

The girl

Which of the following is true of decompensated respiratory failure?

The patient is no longer able to compensate for insufficient oxygen.

What is true of a pediatric patient who demonstrates stridor while in respiratory distress?

The patient probably has an upper airway obstruction.

What is the cause of sudden infant death syndrome (SIDS)?

There is no known cause.

Which of the following is always true about the role of an EMR or EMT during a pediatric poisoning incident?

They must treat the effects of the poisoning in the patient.

Why should the head-tilt, chin-lift maneuver be used with caution in small children?

Tilting back the head may pinch and block the child's airway.

Febrile seizures

are caused by fever.

Toddlers

are children between the ages of 1 and 2 years old.

Adolescents

are children between the ages of 12 and 18 years old

Growth plates

are responsible for the elongation of bones while a child grows.

Fontanelles

are the "soft spots" on a child's head from incomplete closure of skeletal bones

Children generally have faster metabolisms than adults. What is one result of this faster metabolic rate?

children use oxygen and glucose faster than adults

Physical development

concerns all the bodily changes that occur as a person grows and ages

What is the term that is used to describe the ability to share and play with other children, which commonly develops during early childhood years?

cooperative play

Emotional development

deals with changes in a person's ability to establish a unique identity and to express feelings

Which of the following is true of adolescent social development?

develop their own sense of morals and values

Children in the middle childhood stage of development become more dependent and irresponsible as their confidence deteriorates.

false

Children who are in respiratory distress because of an airway disease are given the same emergency care as those with airway obstructions.

false

Children's skin is generally tougher and thicker than adults' skin.

false

EMS providers should communicate with pediatric patients in the same way that they communicate with adult patients.

false

Emotionally, toddlers have no empathy for others.

false

For SIDS infants, a SAMPLE history is not needed because the infant has already passed away.

false

Infants typically have a lower body temperature than all other pediatric age groups.

false

It is important for EMS providers to diagnose SIDS on the field.

false

Males and females experience puberty the same way.

false

Most infants breathe through their mouths.

false

Only unstable pediatric patients should be given ABC management.

false

What is the cause of a febrile seizure in pediatric patients?

fever

greenstick fracture

fractured extremities often occur as a result of bending and then splintering

Adolescence #2

generally occurs between the ages of 12 and 18, is a time of transitioning from childhood to adulthood

early childhood #2

generally occurs between the ages of 2 and 6, children continue to develop physically, intellectually, emotionally, and socially

Middle childhood #2

generally occurs between the ages of 6 and 12, children continue to develop physically, intellectually, emotionally, and socially

Which type of fracture is common in the extremities of children?

greenstick fracture

vital signs for infants include:

heart rate: normal 100 to160 beats per minute respiratory rate: normal 40 to 60 breaths per minute tidal volume: normal fairly shallow systolic blood pressure: average 70 mmHg temperature: normal 98 to 100°F

vital signs for adolescents include:

heart rate: normal 55 to 105 beats per minute respiratory rate: normal 12 to 20 breaths per minute systolic blood pressure: 100 to 120 mmHg temperature: normal 98.6°F

vital signs for middle childhood include:

heart rate: normal 70 to 110 beats per minute respiratory rate: normal 20 to 30 breaths per minute systolic blood pressure: 80 to 120 mmHg temperature: normal 98.6°F

vital signs for early child hood include:

heart rate: normal 80 to 120 beats per minute respiratory rate: normal 20 to 30 breaths per minute systolic blood pressure: 80 to 110 mmHg temperature: normal 98.6 to 99.6°F

vital signs for toddlers include:

heart rate: normal 80 to 130 beats per minute respiratory rate: normal 20 to 30 breaths per minute systolic blood pressure: 70 to 100 mmHg temperature: normal 98.6 to 99.6°F

Which aspect of physical development helps children in the early childhood stage to have greater coordination and balance?

improved motor skills

Infancy

includes children from birth to 1 year old.

Vital Signs for Pediatric Patients include:

infants, toddlers, early childhood, middle childhood, adolescents

Social development

involves learning to interact with other people

pediatric assessment triangle

is a tool that can be used to help assess pediatric patients.

Intellectual development

is also called cognitive development. It deals with a person's ability to learn something and then apply this knowledge to new problems and experiences

Lividity

is discoloration in the body due to the pooling of blood in the lowest body areas

Childhood

is the first stage in a person's life

Sudden infant death syndrome (SIDS)

is when an infant dies unexpectedly, usually during sleep.

Seizures

occur when the electrical signals sent out by the brain are disrupted.

Rigor mortis

occurs after death when the body's joints and muscles become rigid and unmovable. This typically occurs 2 to 4 hours after death.

Decompensated respiratory failure

occurs when a child is no longer able to compensate for insufficient oxygenation

Respiratory arrest

occurs when a patient stops breathing

Infancy #2

refers to the first year of life, babies grow rapidly and progress in many areas of development.

Which of the following is true of adolescent emotional development?

seek to establish their identities

Pediatric Anatomy and Physiology

there are certain anatomical and physiological differences between pediatrics and adults which will affect emergency care

Which of the following is true about the intellectual development of toddlers?

they play make believe and imitate adult actions

A newborn's respiratory rate is normally faster than any other pediatric age group.

true

An infant's tongue is proportionally larger than an adult's tongue.

true

Children have a larger body surface area than adults in relation to their body mass.

true

Children in the middle childhood stage have more self-esteem than those in the early childhood stage.

true

During early childhood, most children are able to see simple situations from someone else's point of view.

true

During middle childhood, children's ability to think logically and understand more complex ideas develops.

true

Following a SIDS incident, EMS providers should offer support to the family and caregivers.

true

In early respiratory distress, an increased respiratory rate is usually able to compensate for insufficient oxygen levels.

true

Most children rely on their diaphragms for breathing.

true

Most toddlers will begin to show signs of gender-stereotypical toy choices.

true

Pediatric patients have an increased risk of airway obstruction.

true

Respiratory arrest often leads to cardiac arrest in pediatric patients.

true

Toddlers are able to feel shame, embarrassment, and pride.

true

upper airway obstruction

will present with signs of stridor, cyanosis and, in the case of severe obstructions, the inability to speak, cry, or cough.

lower airway disease

will present with signs of wheezing, labored exhalations, rapid respiratory rate, and no stridor

The primary assessment for pediatric patients includes the following steps:

•General impression •Pediatric assessment triangle •Initial triage •ABCs

These differences involve the:

•Head •Airway •Chest and lungs •Abdomen •Extremities •Skin •Metabolism •Respiratory system •Nervous system

The basic steps of pediatric assessment that will be covered in this lesson include:

•Preparing for arrival •Scene size-up •Primary assessment •Secondary assessment